Switching genders requires more than surgery

Dr. Loren Schechter thinks the surgery he performs to help people change genders is much more than a medical procedure.

It's the final result of a person's often torturous and years-long effort to have his or her body conform to the gender he or she feels, he said.

The work he does is really "gender confirmation" surgery, said Schechter. "We are not readjusting anything, really. We are making the body congruent with who they know they are," he said.

Schechter said he has treated several hundred patients since he opened his practice, University Plastic Surgery, 11 years ago in Morton Grove. He said he sees five to 10 potential transgender patients each month.

Annually in the United States in recent years, 100 to 500 transgender surgeries have taken place, according to the Human Rights Campaign, a national gay, lesbian, bisexual and transgender civil rights group.

"Surgery is a critical component but only one component," Schechter said. "By the time they (transgender patients) come to me, they are already pretty far along in the process.

"Typically, they are regularly seeing a therapist and working with a (general practitioner) or some other type of medical specialist who is providing them with (hormone replacement treatments)."

People who want to change genders must follow steps outlined by the World Professional Association for Transgender Health's Standards of Care Workgroup before they qualify for the surgery, Schechter said.

Patients are required to:

Provide two independent evaluations about the need to change gender by a medical doctor and a therapist who holds a doctorate

Go under the care of a general practitioner providing regular hormone treatment

Work with a counselor throughout the gender-change process and beyond

Nichole D'Angelo, who went to Schechter in January to make the transition from a man to a woman, said she appreciated his attention to her questions and needs.

"With Dr. Schechter, I get lots of face time, and when I call him with a question, he calls or e-mails me right back. He makes you feel as if you are more important than him," said D'Angelo, 46, who lives in the Atlanta area.

But the biggest reason D'Angelo went to Schechter is that he accepted her form of health insurance.

D'Angelo's surgery has ended up costing her $300 as opposed to the $21,500 she would have needed to pay out of pocket without coverage, she said.

"Once I knew my company had added coverage of gender disorder-related procedures, and I learned Dr. Schechter took my health care insurance, I no longer had an excuse not to do it," D'Angelo said.

The hard work and the surgery to become a woman were worthwhile, she said.

"Surgery is right for me. Not a cure, but now my body matches what it's supposed to be," D'Angelo said. "I love who I am. Don't know what I'll do when I get home but hope to live a normal life, meet a man and have a relationship."

The cost of the medical care is the No. 1 reason people who want to change genders put it off, according to the Human Rights Campaign.

Once the major surgery is completed, people who have changed genders must continue to work on their emotional as well as physical health, Schechter said.

For this reason, in 2001, Schechter joined forces with Dr. Fred Ettner, a general practitioner, and his wife, Randi Ettner, a psychologist who specializes in transgender issues, to form the Chicago Gender Group, whereby they provide transgender patients with a continuity of care.

"Rather than fractured care," Fred Ettner said, "we provide the patient with the very best possible care, whereby the physician is talking with the surgeon and the surgeon is talking with the physician, and all are in regular communication with one another.

"We are providing a seamless approach to well-managed care."

Ettner said Chicago Gender Group wants to provide transgender patients a safe environment in which they would feel comfortable.

"While people are beginning to evolve to the idea of transgender, several years ago I likened it to racial stuff where they would hang you from the nearest tree just for being different," Fred Ettner said.

Schechter said he enjoys working with transgender patients.

"They are a well-informed patient group. They know what they want and have done their research," he said.

Fred Ettner agreed: "They are an extremely grateful, knowledgeable and motivated group. … I love working with this population and I would not give it up."